206 research outputs found
Major abdominal surgery in Jehovahâs Witnesses
Introduction
Patients who are Jehovahâs Witnesses pose difficult ethical and moral dilemmas for surgeons because of their refusal to receive blood and blood products. This article outlines the personal experiences of six Jehovahâs Witnesses who underwent major abdominal surgery at a single institution and also summarises the literature on the perioperative care of these patients.
Methods
The patients recorded their thoughts and the dilemmas they faced during their surgical journey. We also reviewed the recent literature on the ethical principles involved in treating such patients and strategies recommended to make surgery safer.
Results
All patients were supported in their decision making by the clinical team and the Hospital Liaison Committee for Jehovahâs Witnesses. The patients recognised the ethical and moral difficulties experienced by clinicians in this setting. However, they described taking strength from their belief in Jehovah. A multitude of techniques are available to minimise the risk associated with major surgery in Jehovahâs Witness patients, many of which have been adopted to minimise unnecessary use of blood products in general. Nevertheless, the risks of catastrophic haemorrhage and consequent mortality remain an unresolved issue for the treating team.
Conclusions
Respect for a patientâs autonomy in this setting is the overriding ethical principle, with detailed discussion forming an important part of the preparation of a Jehovahâs Witness for major abdominal surgery. Clinicians must be diligent in the documentation of the patientâs wishes to ensure all members of the team can abide by these
Umbrella review and metaâanalysis of antiplatelet therapy for peripheral artery disease
Background
The literature on antiplatelet therapy for peripheral artery disease has historically been summarized inconsistently, leading to conflict between international guidelines. An umbrella review and metaâanalysis was performed to summarize the literature, allow assessment of competing safety risks and clinical benefits, and identify weak areas for future research.
Methods
MEDLINE, Embase, DARE, PROSPERO and Cochrane databases were searched from inception until January 2019. All metaâanalyses of antiplatelet therapy in peripheral artery disease were included. Quality was assessed using AMSTAR scores, and GRADE analysis was used to quantify the strength of evidence. Data were pooled using randomâeffects models.
Results
Twentyâeight metaâanalyses were included. Thirtyâthree clinical outcomes and 41 antiplatelet comparisons in 72â181 patients were analysed. Highâquality evidence showed that antiplatelet monotherapy reduced nonâfatal strokes (3 (95 per cent c.i. 0 to 6) fewer per 1000 patients), In symptomatic patients, it reduced cardiovascular deaths (8 (0 to 16) fewer per 1000 patients), but increased the risk of major bleeding (7 (3 to 14) more events per 1000). In asymptomatic patients, monotherapy reduced nonâfatal strokes (5 (0 to 8) fewer per 1000), but had no other clinical benefit. Dual antiplatelet therapy caused more major bleeding after intervention than monotherapy (37 (8 to 102) more events per 1000), with very lowâquality evidence of improved endovascular patency (risk ratio 4·00, 95 per cent c.i. 0·91 to 17·68).
Conclusion
Antiplatelet monotherapy has minimal clinical benefit for asymptomatic peripheral artery disease, and limited benefit for symptomatic disease, with a clear risk of major bleeding. There is a lack of evidence to guide antiplatelet prescribing after peripheral endovascular intervention
Study of fetomaternal outcome in pre-eclampsia at tertiary care centres, South Gujarat
Background: Hypertensive disorders are among the most common medical disorder during pregnancy and continue to be a serious challenge in obstetric practice. It affects about 7-15% of all gestations. In India it accounts for the third most important cause of maternal mortality. Aim if this study was to study the prevalence of pre-eclampsia and feto-maternal outcome in cases of pre-eclampsia.
Methods: This was a descriptive observational study conducted over a period from February 2019 to July 2021. This study enrolled 106 cases of pre-eclampsia, cases were selected by inclusion and exclusion criteria, data were entered and analysed by using SPSS version 20.
Results: A total of 106 patients were analysed. It was observed that it was more common in age group of 26 to 30 years 51%, 56% were unbooked patients. Maximum number of patients were primigravida 60%, 96% patients were from lower socioeconomic class, 37% patients had normal vaginal delivery, 63% had caesarean delivery. The most common maternal complication was eclampsia (12%), HELLP Syndrome 12%, abruptio occurred in 8% of patients. Maternal mortality occurred in 4 cases. Out of 106 babies 37 (34.93%) babies had normal outcome while 29% (27.35%) had low birth weight, 16 (15.09%) babies were IUGR, 15 (14.5%) babies were IUFD, 7 (6.6%) babies had RDS and 2 (1.8%) babies were stillbirth 40 (44.94%) babies were admitted in NICU.
Conclusions: This study concludes that foetal and maternal outcome were markedly affected by pre-eclampsia and also the grave complications were more common in pre-eclampsia. So proper antenatal care, early diagnosis of pre-eclampsia and timely intervention will decrease maternal perinatal morbidity and mortality
Predicting language diversity with complex network
Evolution and propagation of the world's languages is a complex phenomenon,
driven, to a large extent, by social interactions. Multilingual society can be
seen as a system of interacting agents, where the interaction leads to a
modification of the language spoken by the individuals. Two people can reach
the state of full linguistic compatibility due to the positive interactions,
like transfer of loanwords. But, on the other hand, if they speak entirely
different languages, they will separate from each other. These simple
observations make the network science the most suitable framework to describe
and analyze dynamics of language change. Although many mechanisms have been
explained, we lack a qualitative description of the scaling behavior for
different sizes of a population. Here we address the issue of the language
diversity in societies of different sizes, and we show that local interactions
are crucial to capture characteristics of the empirical data. We propose a
model of social interactions, extending the idea from, that explains the growth
of the language diversity with the size of a population of country or society.
We argue that high clustering and network disintegration are the most important
characteristics of models properly describing empirical data. Furthermore, we
cancel the contradiction between previous models and the Solomon Islands case.
Our results demonstrate the importance of the topology of the network, and the
rewiring mechanism in the process of language change
Advanced Trauma Life SupportÂź. ABCDE from a radiological point of view
Accidents are the primary cause of death in patients aged 45Â years or younger. In many countries, Advanced Trauma Life SupportÂź (ATLSÂź) is the foundation on which trauma care is based. We will summarize the principles and the radiological aspects of the ATLSÂź, and we will discuss discrepancies with day to day practice and the radiological literature. Because the ATLSÂź is neither thorough nor up-to-date concerning several parts of radiology in trauma, it should not be adopted without serious attention to defining the indications and limitations pertaining to diagnostic imaging
Regulation of Kainate Receptor Subunit mRNA by Stress and Corticosteroids in the Rat Hippocampus
Kainate receptors are a class of ionotropic glutamate receptors that have a role in the modulation of glutamate release and synaptic plasticity in the hippocampal formation. Previous studies have implicated corticosteroids in the regulation of these receptors and recent clinical work has shown that polymorphisms in kainate receptor subunit genes are associated with susceptibility to major depression and response to anti-depressant treatment. In the present study we sought to examine the effects of chronic stress and corticosteroid treatments upon the expression of the mRNA of kainate receptor subunits GluR5-7 and KA1-2. Our results show that, after 7 days, adrenalectomy results in increased expression of hippocampal KA1, GluR6 and GluR7 mRNAs, an effect which is reversed by treatment with corticosterone in the case of KA1 and GluR7 and by aldosterone treatment in the case of GluR6. 21 days of chronic restraint stress (CRS) elevated the expression of the KA1 subunit, but had no effect on the expression of the other subunits. Similarly, 21 days of treatment with a moderate dose of corticosterone also increased KA1 mRNA in the dentate gyrus, whereas a high corticosterone dose has no effect. Our results suggest an interaction between hippocampal kainate receptor composition and the hypothalamic-pituitary-adrenal (HPA) axis and show a selective chronic stress induced modulation of the KA1 subunit in the dentate gyrus and CA3 that has implications for stress-induced adaptive structural plasticity
Transformative or Functional Justice? Examining the Role of Health Care Institutions in Responding to Violence Against Women in India
With the growing salience of ideas and reforms concerning womenâs human rights and gender equality, violence against women (VAW) has received heightened policy attention. Recent global calls for ending VAW identify health care systems as having a crucial role in a multisector response to tackle this social injustice. Scholars emphasize the transformative potential of such response in its ability to not only address the varied health consequences but also prevent future recurrence by enabling wider access to support and justice. This wider consensus on the role of health systems, however, demands stronger empirical basis. This article reports findings from an exploratory research developed around the core question: What are the perceived strengths and challenges confronting health systems in offering a comprehensive response to VAW in India? Drawing on site visits, observations, and interviews with front-line staff and program managers of an integrated intervention to tackle violence in Kerala and nongovernment organisation staff in Delhi and Mumbai, the article presents its historical context and key barriers to effective implementation. While promising in terms of outreach and incremental changes in attitudes, barriers include deficits in infrastructure and institutional practices that reinforce inequities in genderâpower relations, hostile attitudes, and limited capacities of health workforce to tackle the complex and diverse needs of women experiencing abuse. Locating these experiences in relation to other models rooted in feminist approach, I argue how conventional intervention models of provisioning fail to challenge institutional contexts and structural inequalities that underpin violence and compound vulnerabilities experienced by women, thereby serving a functional response. Health systems are social institutions embedded in prevailing gender norms and power relations that must be tackled alongside addressing imminent needs of women victims of abuse. To this end, feminist approaches to counselling and relational perspectives to social justice can strengthen responsiveness (and transformative potential) of integrated sector-wide interventions
Documenting the Recovery of Vascular Services in European Centres Following the Initial COVID-19 Pandemic Peak: Results from a Multicentre Collaborative Study
Objective: To document the recovery of vascular services in Europe following the first COVID-19 pandemic peak. Methods: An online structured vascular service survey with repeated data entry between 23 March and 9 August 2020 was carried out. Unit level data were collected using repeated questionnaires addressing modifications to vascular services during the first peak (March â May 2020, âperiod 1â), and then again between May and June (âperiod 2â) and June and July 2020 (âperiod 3â). The duration of each period was similar. From 2 June, as reductions in cases began to be reported, centres were first asked if they were in a region still affected by rising cases, or if they had passed the peak of the first wave. These centres were asked additional questions about adaptations made to their standard pathways to permit elective surgery to resume. Results: The impact of the pandemic continued to be felt well after countriesâ first peak was thought to have passed in 2020. Aneurysm screening had not returned to normal in 21.7% of centres. Carotid surgery was still offered on a case by case basis in 33.8% of centres, and only 52.9% of centres had returned to their normal aneurysm threshold for surgery. Half of centres (49.4%) believed their management of lower limb ischaemia continued to be negatively affected by the pandemic. Reduced operating theatre capacity continued in 45.5% of centres. Twenty per cent of responding centres documented a backlog of at least 20 aortic repairs. At least one negative swab and 14 days of isolation were the most common strategies used for permitting safe elective surgery to recommence. Conclusion: Centres reported a broad return of services approaching pre-pandemic ânormalâ by July 2020. Many introduced protocols to manage peri-operative COVID-19 risk. Backlogs in cases were reported for all major vascular surgeries
BLOOM: A 176B-Parameter Open-Access Multilingual Language Model
Large language models (LLMs) have been shown to be able to perform new tasks
based on a few demonstrations or natural language instructions. While these
capabilities have led to widespread adoption, most LLMs are developed by
resource-rich organizations and are frequently kept from the public. As a step
towards democratizing this powerful technology, we present BLOOM, a
176B-parameter open-access language model designed and built thanks to a
collaboration of hundreds of researchers. BLOOM is a decoder-only Transformer
language model that was trained on the ROOTS corpus, a dataset comprising
hundreds of sources in 46 natural and 13 programming languages (59 in total).
We find that BLOOM achieves competitive performance on a wide variety of
benchmarks, with stronger results after undergoing multitask prompted
finetuning. To facilitate future research and applications using LLMs, we
publicly release our models and code under the Responsible AI License
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